HHSC will revise the Nucala clinical prior authorization criteria section in the Molononal Antibody Agents for Asthma (PDF) clinical prior authorization following the US Food and Drug Administration (FDA) approved indications. Nucala is a monoclonal antibody prescribed as maintenance therapy for patients 6 years and older with severe eosinophilic asthma. However, the autoinjector and prefilled syringe products are only FDA-approved for at-home use for adults and adolescents age 12 and older.
This clinical prior authorization is optional for MCOs. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each MCO uses and how those authorizations relate to those used for processing fee-for-service Medicaid claims. This chart is updated quarterly. Providers can also refer to the MCO Resources for links to each MCO’s list of clinical prior authorizations.